MEDICARE: MICHAEL BACKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	16675	CT
2	163W00000X	Registered Nurse	10.212557	CT

General Provider Information

NPI Number	:	1841002300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BACKMAN

Provider Business Mailing Address
First Line	:	22 CUMPSTONE DR
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-2423
Country	:	US
Telephone Number	:	940-206-5033
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 CUMPSTONE DR
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-2423
Country	:	US
Telephone Number	:	940-206-5033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	03/12/2026

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Directions to “ MICHAEL BACKMAN ” Practice Location

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